Hypochondriacal Fears Research Articles

Hypochondriacal Fears and Beliefs, Anxiety, and Somatisation

Four self-rating scales of hypochondriasis and the Symptom Checklist-90 were administered to 100 general practice (GP) patients and matched non-psychotic psychiatric out-patients. In a stepwise linear regression, self-rated somatic symptoms and anxiety predicted hypochondriacal fears and beliefs; self-rated depression did not appear as a predictor. There were differences between males and females and between psychiatric patients and GP patients in the associations of these constructs. These results varied in part with the scale of hypochondriasis used. Various scales of hypochondriasis appear to measure different features of the hypochondriasis syndrome. Fear of disease (disease phobia) was associated with anxiety, whereas a false belief of having a disease (disease conviction) was associated more with somatic symptoms.

Panic disorder and hypochondriacal fears and beliefs

The purpose of this study was to examine correlates of hypochondriacal fears and beliefs in patients with panic disorder (PD) ( n = 54). They were evaluated using the structured diagnostic interviews for axis I and axis II disorders (SCID-UP-R and SCID-II). They were administered the Illness Attitudes Scales (IAS) as a measure of hypochondriacal fears and beliefs, the Hopkins Symptom Checklist 90 (HSCL), and the Fear Questionnaire (FQ). One half of the patients rated themselves as having substantial hypochondriacal fears and beliefs. The sample was divided into groups of patients seeking predominantly treatment or relief from symptoms (treatment-oriented), and those who were searching for a cause of their illness (explanation-seeking): the latter had significantly more hypochondriacal concerns. Avoidant, histrionic, and borderline personalities were more common in the hypochondriacal group. The results of several analyses suggest that patients with PD who are also agoraphobic, fear physical disease more and have more false beliefs of having a disease than PD patients without agoraphobia.

Dr. Fava and Associates Reply

SIR: In “Prodromal Symptoms in Panic Disorder With Agoraphobia” (1), Giovanni A. Fava, M.D., and associates reported that of 20 patients suffering from panic disorder with agoraphobia, 18 had experienced agoraphobic avoidance, generalized anxiety, and/or hypochondriacal fears and beliefs during the 6 months before the first panic attack. Normal control subjects reported significantly fewer of these phenomena in the 6 months before they had an identical interview. Dr. Fava and his colleagues concluded from these data that agoraphobic symptoms are more primary than panic attacks in panic disorder with agoraphobia-a reversal of the causal sequence assumed in DSM-III-R. Imipramine’s effects in agoraphobic patients originally suggested that panic attacks were the primary disturbance in most such patients and that anticipatory anxiety and agoraphobic avoidance followed as reactions to the initially unexpected anxiety episodes (2). As noted by Dr. Fava and associates, several subsequent investigations generally affirmed this phenomenological sequence. Limiting the usefulness of the data from Dr. Fava’s group are three important methodological issues. First, it is unclear whether the patients and control subjects were interviewed about prior symptoms by persons blind to diagnosis, so as to avoid investigator bias. Second, the degree of agoraphobia, generalized anxiety, or hypochondria found in the patient group before panic onset was not specified. While it appears that these levels exceeded some threshold and therefore differed from what was found in the control subjects, the investigators did not specify whether the patients suffered clinically severe agoraphobic symptoms before their panics began or whether these developed only after the onset of panic. Also, Dr. Fava and colleagues cited Weissman and Merikangas’s finding (3) that a sizable percentage of agoraphobic patients in epidemiological samples did not have panic attacks, but without specifying that many of them had limited-symptom (partial panic) attacks. This does not appear to have been investigated by Dr. Fava’s group.

Hypochondriacal fears and beliefs in pregnancy

Illness attitudes were evaluated in 26 pregnant women and 26 control subjects matched for sociodemographic variables, by means of a self-rating scale, on 3 different occasions. For each trimester of pregnancy, women displayed more hypochondriacal fears and beliefs and conviction of disease (disease phobia) than normal controls. In the third trimester, they also reported more fear of dying and bodily preoccupations. The findings should alert physicians to ask their pregnant patients whether they are preoccupied with fear of dying, or are concerned that they suffer from an undiagnosed physical illness, or dread a specific illness such as cancer or heart disease. Hypochondriacal fears and beliefs are liable to affect well-being and the health attitudes of pregnant women. If properly recognized, they may effectively be treated.

Hypochondriacal Symptoms in Pregnancy

Illness attitudes were evaluated in 26 pregnant women and 26 control subjects matched for sociodemographic variables, by means of a self-rating scale, on three different occasions. In each trimester of pregnancy, women displayed more hypochondriacal fears and beliefs and conviction of disease (disease phobia) than normal controls (p less than 0.001). The findings should alert physicians to ask their pregnant patients whether they are preoccupied with fear of dying, or are concerned that they suffer from an undiagnosed physical illness, or dread a specific illness such as cancer or heart disease. Hypochondriacal fears and beliefs are liable to affect the well-being and health attitudes of pregnant women. If properly recognized, they may effectively be treated.

Prodromal symptoms in panic disorder with agoraphobia.

Of 20 patients suffering from panic disorder with agoraphobia, 18 reported experiencing agoraphobic avoidance, generalized anxiety, and/or hypochondriacal fears and beliefs before the first panic attack. The prevalence of these symptoms in the patients was significantly higher than the prevalence in 20 healthy control subjects. The results indicate that phobic avoidance in panic disorder with agoraphobia may not be secondary to the panic attacks, a finding that runs counter to the current DSM-III-R classification of anxiety disorders.

Distress and attitudes in patients perceived as hypochondriacal by medical staff

The aim of this study was to examine the characteristics of patients perceived by general physicians as hypochondriacal. The authors requested physicians at a general hospital to refer patients for a study of hypochondriasis. In order to measure depression, anxiety, and somatic symptoms, the authors administered several rating and self-rating scales, and to measure hypochondriacal attitudes they administered the Illness Attitude Scales (IAS) and the Illness Behavior Questionnaire (IBQ). The referred patients (N = 29) had more psychiatric disorders, were more depressed and more anxious, and had more severe somatic symptoms than matched medical patients who had not been referred. Self-rated hypochondriacal fears and beliefs did not differ significantly between the groups. Five of the referred patients (17%) whose initial diagnosis was hypochondriasis were subsequently found to have physical diseases that accounted for their symptoms. The implications of these findings for treatment are discussed.

Hypochondriacal fears and beliefs in agoraphobia

In order to evaluate hypochondriacal fears and beliefs in agoraphobia, the authors administered the self-rated Illness Attitude Scales to 18 agoraphobic patients. The patients reported hypochondriacal concerns similar to those of patients with hypochondriasis. After agoraphobia had been treated with exposure therapy in ten patients, hypochondriacal concerns did not differ significantly from those of normals. The findings suggest that hypochondriacal concerns are substantial in agoraphobia and that these wane when anxiety decreses.

Hypochondriacal fears and beliefs in medical and law students.

We administered two validated scales of hypochondriacal concerns (the Illness Behavior Questionnaire and the Illness Attitude Scales) to 60 medical students and matched law students. Medical students took more precautions about their health and attended more to somatic symptoms, but the prevalence of hypochondriacal fears, beliefs, and attitudes did not differ significantly between the two groups. Five students (8.3%) in each group scored in the range of patients with hypochondriacal neurosis. Most of the students were free of these concerns. The prevalence of hypochondriacal concerns in medical students was substantially lower than the previously reported incidence over four years of study; this supports the previous observation that most of these reactions are short lived.

A guide to the literature on aggressive behavior

A guide to the literature on aggressive behavior

Hypochondriacal fears and beliefs in DSM-III melancholia: Changes with amitriptyline

The authors administered the Illness Attitude Scales, which identify hypochondriacal patients, to 20 nonpsychotic inpatients with DSM-III diagnosis of melancholia before and after 4 weeks of treatment with amitriptyline, and to a matched group of normals. Before treatment characteristic hypochondriacal responses occured in over one-third of melancholics whereas after treatment the number was the same as in normals. The findings are in accord with the clinical observation that melancholia is one of the causes of hypochondriacal fears and beliefs and these tend to remit with recovery from depression.

Hostility, somatic symptoms, and hypochondriacal fears and beliefs.

The authors administered self-rating scales of anger-hostility, somatic symptoms, and hypochondriacal fears and beliefs to seven groups of patients and nonpatients. Somatic symptoms were positively correlated with anger-hostility and were negatively correlated with feelings of friendliness; the correlation coefficients ranged from low to moderately high and were significant in most groups. Somatic symptoms tended to be associated more strongly with symptoms of anxiety and depression than with those of hostility. The associations of hypochondriacal fears and beliefs with hostility were inconsistent, varied between groups and with the concern measured. The findings do not support the view that anger or hostility are main or specific etiological factors either in somatization or in hypochondriacal fears or beliefs.